South Africa unveils national HIV/AIDS treatment programme



Sarah Jane Marshall




The South African Cabinet approved a national HIV/AIDS treatment pro-gramme on 19 November 2003 representing a major policy change for President Thabo Mbeki's government which had been criticized for failing to tackle the AIDS pandemic.

The programme plans to distribute free antiretroviral drugs through service points in every health district within one year and in every local municipality within five years. It aims to treat about 1.2 million people by 2008.

It is not yet clear when the drugs will be made available. Dr Manto Tshabalala-Msimang, South Africa's Minister of Health, said that the government still needed to put out a tender for the drugs, train health care workers and identify and upgrade distribution centres, particularly in rural areas. "There is still a long way to go," she said. "I don't want to raise false hopes, but a decision has been made. There is hope."

"This is a far-reaching decision which demonstrates that the South African Government is ready to play a stronger role in meeting the challenge of treating millions of people living with AIDS in Africa," said Dr LEE Jong-wook, Director-General of the World Health Organization.

The programme's treatment goals were brought further within reach following an agreement on 10 December by pharmaceutical companies, GlaxoSmithKline and Boeringer Ingelheim, to permit large-scale manufacture of generic versions of their patented HIV/AIDS drugs for the country, following an out-of-court settlement with South African's Treatment Action Campaign.

Around 5 million people in South Africa are currently HIV-positive — that's 11% of the country's total population of 47 million. WHO estimates that around 15% of the total HIV-positive population are in need of treatment — higher than anywhere else in the world. By 2008, this figure will have increased as more people reach the final stages of the disease. The programme's 1.2 million target figure includes this projected increase.

"South Africa's bold move to ensure that millions of HIV-positive people have access to treatment should mobilize other African governments to make treatment a reality for those infected," said Dr Peter Piot, UNAIDS Executive Director, welcoming the new phase in South Africa's response to AIDS. The South African Government had previously been criticized by AIDS activists for asserting that HIV did not cause AIDS and for questioning the effectiveness of anti-retroviral drugs.

The treatment programme is part of a wider plan known as the "Operational Plan for Comprehensive Treatment and Care for HIV and AIDS" presented to the Cabinet by the Minister of Health on 19 November. The Cabinet had requested the Department of Health to prepare the plan on 8 August 2003. It represents the final part of the National Strategic Plan for HIV and AIDS 2000-2005.

As well as treatment, the plan also includes a prevention campaign, an education and mobilization programme to strengthen partnership within the community, the expansion of pro-grammes aimed at improving HIV patients' immune systems and slowing down the effects of HIV infection, the treatment of opportunistic infections and intensified support for families affected by HIV/AIDS.



The South African Government plans to spend over US$ 1.73 billion over the next three years to combat HIV/AIDS, of which US$ 270 million is to be set aside for antiretrovirals. The cabinet stated that the funds should be "new money" — in other words money not taken from other health care, development or social service programmes.

"The decision to provide free anti-retroviral treatment is a very positive development," said Dr Charles Gilks, Coordinator of WHO's 3-by-5 initiative which aims to provide antiretroviral treatment to 3 million people living with AIDS by 2005. "But now the difficult decision of who gets the drugs must be made. New programmes have to begin somewhere. Countries starting new HIV/AIDS treatment initiatives are now facing this problem — how to decide where to start. They need to make clear choices. They need to decide who is mandated to make these choices."

The Consultation on Ethics and Equity in HIV/AIDS Care which will take place at WHO, Geneva on 26–27 January 2004 aims to identify and review the issues raised in deciding who will benefit first from HIV/AIDS treatment programmes. "It will review what choices need to be made and what the potential options are so that countries can decide who to involve and what key issues should be included in making such difficult decisions," said Gilks.

World Health Organization Genebra - Genebra - Switzerland